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Hemangioendotheliomas and arteriovenous malformations (AVMs) of the liver often cause congestive heart failure in babies, but embolization of the hepatic artery is not always effective. Six newborns and infants (four with hemangioendotheliomas and two with AVMs) underwent abdominal aortography, hepatomesenteric arteriography, and angiography of arterial and portal collateral vessels prior to embolization of the hepatic artery for heart failure (n = 5) and portal hypertension (n = 1). In addition, extrahepatic arteries were embolized in one patient and a portal vein branch in another. Extrahepatic arterial collaterals from the superior mesenteric, intercostal, phrenic, and adrenal arteries were seen in five patients; portal vein connections, in two patients. Embolization was therapeutically most effective in the baby with the least collateral supply and in the two patients in whom arterial collaterals or portal venous connections were embolized. Angiographic documentation and possibly embolization of collateral flow is required to improve treatment planning and success in these severely ill patients.

Congenital arteriovenous malformations (AVMs) with multiple arterial feeders in eight patients were managed by transcatheter embolization with a combination of polyvinyl alcohol foam (Ivalon), detachable silicone balloons, and wool coils. Due to the extensive number of arterial feeders often present, multiple procedures with several days in between were frequently necessary. When possible, surgical resection after embolization is the procedure of choice. Inoperable AVMs are best managed by segmental distal embolization of all arterial feeders with a permanent occluding material. Embolization therapy as a primary form of management is considered palliative and temporary relief of symptoms is usually achieved.

A surviving case of infantile hepatic hemangioendothelioma is presented. The patient was treated with a combination of radiation therapy, cytotoxan, and prednisone, resulting in regression of the tumor.

Two infants with severe congestive cardiac failure secondary to diffuse hepatic hemangiomas were treated by percutaneous transcatheter embolization of the hepatic arteries using detachable silicone balloons. One infant experienced dramatic improvement of the cardiac failure and showed no impairment of hepatic function. The other infant remained in a low cardiac output state following the procedure and developed acute hepatic and renal failure followed by generalized sepsis and death. Autopsy examination revealed massive hepatic hemangioendothelioma as well as areas of necrotic and viable liver parenchyma. A review of reported patients with hepatic hemangiomas treated by hepatic artery ligation or embolization showed no others who had hepatic failure. These techniques were curative in 14 of 18 patients (78%), an improvement compared with the results of other available methods of therapy.

Computed tomography (CT) was performed in three children with hepatoblastoma, hepatocellular carcinoma, or hemangioendotheliomatosis. In each case the tumor was identified as a mass with a lower attenuation value than surrounding normal liver tissue. However, the hemangioendothelioma became almost undetectable after intravenous injection of contrast agent. Identification of the intersegmental fissure of the left lobe allowed correct prediction of the segmental location of the solitary lesion (hepatoblastoma and hepatocellular carcinoma) in the two patients who underwent subsequent partial hepatic resection.